Surgical guide with cut resistant inserts

ABSTRACT

A resection guide can be configured to guide a resection tool toward a graft source or a tissue body. The resection guide can include a resection guide body with at least one opening, and a guide member configured to be at least partially inserted into the at least one opening.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is continuation of U.S. application Ser. No.13/792,849, entitled “Surgical Guide with Cut Resistant Inserts” filedMar. 11, 2013, now pending, which claims the benefit of U.S. ProvisionalPatent Application Ser. No. 61/642,063 filed May 3, 2012, U.S.Provisional Patent Application Ser. No. 61/645,890 filed May 11, 2012,and also U.S. Provisional Patent Application Ser. No. 61/699,938 filedSep. 12, 2012. Each application identified above is incorporated hereinby reference in its entirety for all purposes.

FIELD OF DISCLOSURE

The present application generally relates to a surgical resection guide,and in particular relates to a surgical resection guide that isconfigured to guide one or more tools to cut and/or prepare a tissue,such as bone.

BACKGROUND

Many surgical procedures require accurate cuts of bone. For example, inmandibular reconstruction surgery, deficient or infectious portions ofthe mandible may be removed from the patient and replaced with bonegraft. In some instances, a surgeon performing orthognathic surgerytypically makes several cuts on the mandible to properly fit a bonegraft. To make an accurate cut, the surgeon may use a patient specificresection guide to guide the motion of the resection tool toward thebone. The resection guide can also be used while cutting a bone portionfrom other parts of the patient to harvest bone grafts.

The resection guide may wear over time due to the friction exerted bythe resection tool on the resection guide during use. This wear mayreduce the accuracy of the resection guide and produce wear debris. Weardebris stemming from the resection guide could be detrimental to thelong-term efficacy of the bone graft.

SUMMARY

The present disclosure relates to surgical system for reconstructing atleast a portion of a tissue body with a graft. The surgical system caninclude a resection guide that is configured to guide a one or moretools toward a graft source or tissue body. In one embodiment, theresection guide can include a resection guide body and a guide member.The resection guide body can be at least partially made from a firstmaterial, and defines an upper body surface and a lower body surfacethat is opposite the upper body surface. The lower body surface isconfigured to face or be placed against the graft source or tissue body.Further, the resection guide body can define a first resection guideopening and a second resection guide opening that is spaced from thefirst resection guide opening. The first and second resection guideopenings can extend from upper body surface to the lower body surface.The guide member can be configured to be at least partially inserted inat least one of the first resection guide opening or the secondresection guide opening. The guide member can include a guide memberbody and a guide member opening that extends through the guide memberbody. The guide member opening is elongate along a graft resection axis.The guide member opening can be configured to receive at least a portionof the resection tool and guide the resection tool along the graftresection axis when the resection tool is received in the guide memberopening. The guide member can be at least partially made of a secondmaterial that is harder than the first material. Another embodiment ofthe present disclosure is a metallic resection guide member. Themetallic resection guide member has a body that includes an upper bodysurface and a lower body surface opposite the upper body surface. Thelower body surface is configured to face the graft source or the tissuebody when disposed adjacent the respective graft source or tissue body.The metallic resection guide body can define at least one resectionguide opening that is configured to receive a portion of the resectiontool so as to guide the resection tool.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing summary, as well as the following detailed description ofa preferred embodiment, are better understood when read in conjunctionwith the appended diagrammatic drawings. For the purpose of illustratingthe invention, the drawings show an embodiment that is presentlypreferred. The invention is not limited, however, to the specificinstrumentalities disclosed in the drawings. In the drawings:

FIG. 1A is a perspective view of a surgical resection guide placed overa graft source according to an embodiment of the present disclosure;

FIG. 1B is a front elevation view of first and second graft portionsharvested from the graft source shown in FIG. 1A;

FIG. 1C is a perspective view of the skull of FIG. 1A, showing amandible that has been resected so as to define a cavity;

FIG. 1D is a perspective view of a reconstructed mandible, showing agraft formed by coupling the first graft portion and the second graftportion shown in FIG. 1B inserted into the cavity shown in FIG. 1C;

FIG. 1E is perspective view of a skull that includes a mandible, whichin turn includes a diseased tissue portion, and a surgical resectionguide coupled to the mandible;

FIG. 1F is a perspective view of a virtual model of the skull shown inFIG. 1E, showing a graft superimposed over the diseased tissue portion;

FIG. 1G is a perspective view of a virtual model of a graft source,showing surgically planned resection suitable to create the first andsecond graft portions illustrated in FIG. 1B;

FIG. 2A is a front perspective view of a resection guide of FIG. 1Aincluding a resection guide body and guide members;

FIG. 2B is an enlarged perspective view of a portion of the resectionguide illustrated in FIG. 2A, taken at region 2B and showing a firstresection guide supporting member and a first connecting member;

FIG. 2C is an enlarged perspective view of a portion of the resectionguide shown in FIG. 2A, taken at region 2C and showing second and thirdresection guide supporting members, the first connecting member, asecond connecting member, and a third connecting member;

FIG. 2D is an enlarged perspective view of a portion of the resectionguide depicted in FIG. 2A, taken at region 2D and showing a fourthresection guide supporting member and the third connecting member;

FIG. 2E is a rear perspective view of the resection guide shown in FIG.2A;

FIG. 3 is a perspective view of the guide member shown in FIG. 2A;

FIG. 4 is a perspective sectional view of the guide member illustratedin FIG. 3 disposed in the first resection guide supporting memberillustrated in FIG. 2A, taken along section line 4-4 of FIG. 2A;

FIG. 5 is a perspective view of a guide member in accordance to anotherembodiment of the present disclosure;

FIG. 6A is a perspective view of a resection guide in accordance with anembodiment of the present disclosure that includes a resection guidebody and discrete guiding components;

FIG. 6B is an enlarged perspective view of a portion of the resectionguide sown in FIG. 6A and one discrete guiding component being coupledto the resection guide body;

FIG. 7 is a perspective view of a resection guide in accordance with anembodiment of the present disclosure;

FIG. 8 is a perspective view of a resection guide in accordance with anembodiment of the present disclosure that is made of a single material.

FIG. 9A is a perspective view of a resection guide placed over a graftsource, including a resection guide body and guide members, according toanother embodiment of the present disclosure;

FIG. 9B is a front perspective view of a resection guide of FIG. 9Aincluding a resection guide body, guide members and a support member;

FIG. 9C is a plan view of a portion of the resection guide of FIG. 9A,illustrating a drilling guide member;

FIG. 9D is a perspective view of drilling guide member shown in FIG. 9C;

FIG. 9E is a cross-sectional view of the drilling guide member takenalong line 9E-9E in FIG. 9C;

FIG. 9F is a cross-sectional view of the drilling guide member takenalong line 9E-9E in FIG. 9C, according to another embodiment of thepresent disclosure;

FIGS. 10A through 10C are cross-sectional views of the resection guidetaken along lines 10A-10A, illustrating various orientations of thedrilling guide member on the resection guide body, according to anembodiment of the disclosure;

FIGS. 11A through 11B are cross-sectional views of the resection guidetaken along lines 11-11, illustrating the orientations of the drillingguide member on the resection guide body, according to an embodiment ofthe disclosure

FIG. 12A is a perspective view of a resection guide coupled to a skullaccording to an embodiment of the present disclosure; and

FIG. 12B illustrates the resection guide shown in FIG. 12A.

DETAILED DESCRIPTION OF THE DRAWINGS

Certain terminology is used in the following description for convenienceonly and is not limiting. The words “right”, “left”, “lower” and “upper”designate directions in the drawings to which reference is made. Thewords “proximally” and “distally” refer to directions toward and awayfrom, respectively, the surgeon using the surgical device. The words,“anterior”, “posterior”, “superior”, “inferior” and related words and/orphrases designate preferred positions and orientations in the human bodyto which reference is made and are not meant to be limiting. Theterminology includes the above-listed words, derivatives thereof andwords of similar import.

With reference to FIG. 1A, a surgical system 10 be used to reconstructat least a portion of a tissue body 400 with a graft 408 (FIG. 1D). Thetissue body 400 can include at least one of anatomical tissue or atissue substitute. The term anatomical tissue can include hard tissuesuch as bone. For instance, the tissue body 400 can include a mandible402. The surgical system 10 can be configured to remove a diseasedtissue portion 404 (FIG. 1E), such as a damaged tissue portion, from thetissue body 400, harvest the graft 408 from a graft source 403, andreplace the diseased tissue portion 404 with the graft 408.

In an embodiment, the surgical system 10 can include a resection guide50 that is configured to harvest the graft 408 (FIG. 1E) from the graftsource 403 and prepare the graft 408 for positioning and securement tothe tissue body 400. In particular, the resection guide 50 can beconfigured to guide a resection tool 300 (FIG. 1E) toward the graftsource 403 along one or more predetermined graft resection axes. Forinstance, the resection guide 50 can be configured to a guide theresection tool 300 along graft resection axes 591, 593, 595, and 597.The graft resection axes 591, 593, 595, and 597 can be predeterminedwith the aid of virtual models of the graft source 403 and diseasedtissue portion 404 (FIG. 1E) as discussed detail below. In otherembodiments, the resection guide can also be configured to guide adrilling tool 310 (FIGS. 9A and 12A) into the tissue body 400 or graftsource 403. For instance, the resection guide can be configured to guidea tool, such as drill bit along an anchor location axis 319 to form abore in the graft source 403 or tissue body 400 that is sized to receivean anchor therein, for instance for coupling a bone plate to the graft408 and tissue body 400. The location and orientation of the anchorlocation axis 319 can also be predetermined with the aid of virtualmodels of the graft source 403, the tissue body 400, including thediseased tissue portion 404 (FIG. 1E), and a bone fixation element, asdiscussed detail below. Thus, the resection guide 50 can be patientspecific. That is, the resection guide 50 can guide the resection tool300 toward the graft source 403 to create one or more graft portionsthat are sized and shaped to properly replace the diseased tissueportion 404 (FIG. 1E) of the tissue body 400.

With reference to FIG. 1A, the resection guide 50 can be configured toguide a resection tool 300 (FIG. 1E) toward the graft source 403 toresect a portion of the graft source 403 in order to create the graft408 (FIG. 1D). The graft 408 can be shaped and sized to replace thediseased tissue portion 404 (FIG. 1E) that is removed from the tissuebody 400. The graft source 403 can be a long bone, such as the fibula405. Alternatively, the graft source 403 can be other bones such as thescapula, hip, forearm, among others. The resection guide 50 can includea resection guide body 580 that in turn can include one or moreresection guide supporting members. As further detailed below, theresection guide can include one or more drill guide member 900 (FIG.9A).

Each resection guide supporting member is configured to support a guidemember as discussed in detail below. In the depicted embodiment, theresection guide body 580 can include a first resection guide supportingmember 502, a second resection guide supporting member 542, a thirdresection guide supporting member 562, and a fourth resection guidesupporting member 582.

The first resection guide supporting member 502 can define a firstresection guide opening 504. Thus, the resection guide body 580 candefine the first resection guide opening 504. The first resection guideopening 504 can be shaped and oriented relative to the resection guidebody 580 such that the resection guide opening 504 can guide theresection tool 300 (FIG. 1E) along a first resection axis 591 definedalong the graft source 403 when the resection guide 50 is coupled to thegraft source 403.

The second resection guide supporting member 542 can define a secondresection guide opening 544. Thus, the resection guide body 580 candefine the second resection guide opening 544. The second resectionguide opening 544 can be spaced from the first resection guide opening504. The first resection guide opening 504 and the first resection guideopening 544 can extend through the upper body surface 581 and the lowerbody surface 577. The second resection guide opening 544 can be shapedand oriented relative to the resection guide body 580 such that thesecond resection guide opening 544 can guide the resection tool 300(FIG. 1E) along a second graft resection axis 593 defined along thegraft source 403 when the resection guide 50 is coupled to the graftsource 403.

The third resection guide supporting member 562 can define a thirdresection guide opening 564. The third resection guide opening 564 canbe shaped and oriented relative to the resection guide body 580 suchthat the third resection guide opening 564 can guide the resection tool300 (FIG. 1E) along a third graft resection axis 595 when the resectionguide 50 is coupled to the graft source 403.

The fourth resection guide supporting member 582 can define a fourthresection guide opening 584. The fourth resection guide opening 584 canbe shaped and oriented relative to the resection guide body 580 suchthat the fourth resection guide opening 584 can guide the resection tool300 (FIG. 1E) along a fourth resection graft axis 597 when the resectionguide 300 is coupled to the graft source 403. The resection guide 50 canfurther defines the third resection guide opening 564 and the fourthresection guide opening 584 that is spaced from the third resectionguide opening 564. The third and fourth resection guide openings 564 and584 can be configured to receive at least a portion of the resectiontool 300 so as to resect a second graft portion 411 from the graftsource 403. The resection guide body 580 can define more than fourresection guide openings. Also, the resection guide body 580 can definefewer than four resection guide openings.

With continuing reference to FIG. 1A, the resection guide body 580 canfurther include a first connection member 520 that couples the firstresection guide supporting member 502 to the second resection guidesupporting member 542, a second connecting member 550 that couples thesecond resection guide supporting member 542 to the third resectionguide supporting member 562, and a third connecting member 570 thatcouples the third resection guide supporting member 562 to the fourthresection guide supporting member 584. The resection guide body 580 canfurther define one or more holes 587 that are configured to receive afastener, such as a bone screw. The fasteners can be inserted throughthe holes 587 to fix the resection guide body 580 to the graft source403. The holes 587 can be located, for example, along the firstconnecting member 520 and the third connecting member 580.

With continuing reference to FIG. 1A, the resection guide 50 can beshaped and contoured to fit only over a portion of the graft source 403such that the resection guide openings 504, 544, 564, and 584 aresubstantially aligned with the graft resection axes 591, 593, 595, and597, respectively. Thus, in operation, the resection guide 50 can beplaced on the graft source 403 such that the resection guide openings504, 544, 564, and 584 are substantially aligned with the graftresection axes 591, 593, 595, and 597, respectively. Then, the resectionguide 50 can be coupled to the graft source 403 by, for example,inserting fasteners through the holes 587 and into the graft source 403.The resection tool 300 (FIG. 1E) can be inserted through the firstresection guide opening 504 to make a resection, such as a cut, into thegraft source 403 along the first graft resection axis 591. The resectiontool 300 (FIG. 1C) can be inserted through the second resection guideopening 544 and into the graft source 403 to make a resection, such as acut, into the graft source 403 along the second graft resection axis593. Resections can be made to the graft source 403 along the firstgraft resection axis 591 and the second graft resection axis 593 toobtain the first graft portion 409 (FIG. 1B). The resection tool 300(FIG. 1A) can be inserted through the third resection guide opening 564and into the graft source 403 to make a resection, such as a cut, intothe graft source 403 along the third graft resection axis 595. Further,the resection tool 300 (FIG. 1A) can be inserted through the fourthresection guide opening 584 and into the graft source 403 to make aresection, such as a cut, into the graft source 403 along the fourthresection axis 597. Resections can be made to the graft source 403 alongthe third graft resection axis 595 and the fourth graft resection axis597 to obtain a second graft portion 411 (FIG. 1B). The resection guide50 can then be detached from the graft source 403.

With reference to FIG. 1B, after making resection into the graft source403 along the graft resection axes 591, 593, 595, and 597, the firstgraft portion 409 and the second graft portion 411 can be removed fromthe graft source 403 (FIG. 1E). At this point, the first graft portion409 and the second graft portion 411 can be two separate elements.However, the first graft portion 409 and the second graft portion 411can be coupled to each other to form the graft 408 (FIG. 1D). In otherwords, the first graft portion 409 and the second graft portion 411 cancooperate to define the graft 408.

With reference to FIG. 1C, a tissue portion of the tissue body 400, suchas the diseased tissue portion 404 (FIG. 1E), can be resected from thetissue body 400, thereby forming a cavity 407. In the depictedembodiment, the cavity 407 is defined by the resected or cut portion ofthe ramus at one end, and resected or cut portion the mentalprotuberance at the other end of the cavity. The first graft portion 409and the second graft portion 411 can be interconnected to form the graft408, which is shaped and sized to fit in the cavity 407 so as to replacethe tissue portion removed from the tissue body 400.

With reference to FIG. 1D, the first graft portion 409 and the secondgraft portion 411 can cooperate to define the graft 408. For example,the first graft portion 409 and the second graft portion 411 can becoupled to the tissue body 400 and to each other, such that the firstgraft portion 409 and the second graft portion 411 can together fit inthe cavity 407, thereby replacing the tissue portion previously removedfrom the tissue body 400. As discussed above, the first graft portion409 and the second graft portion 411 can be coupled to each other so asto define the graft 408. Thus, the graft 408 can replace the tissueportion removed from the tissue body 400, such as the diseased tissueportion 404 (FIG. 1A).

With reference to FIG. 1E, the surgical system 10 can further includethe resection tool 300 that is configured to resect, such as cut, thetissue body 400, and a resection guide 200, that is configured to becoupled to the tissue body 400 to guide the movement of the resectiontool 300 toward the tissue body 400. The surgical system 10 can alsoinclude drilling tool 310 configured to form anchor locations in thetissue body 400 or graft source 403 as detailed below. The resectionguides can also be configured to guide movement of the drilling tool 310toward the tissue body 400 (FIG. 12A) or graft source 403 (FIG. 9A).

The resection tool 300 is configured to resect, such as cut, the tissuebody 400, and can be a chisel, a saw, a blade, or any tool capable ofresecting, such as cutting, the tissue body 400. The resection guide 200can be configured to guide advancement of the resection tool 300 towardthe tissue body 400 and can include a resection guide body 202 and aconnecting member 204 connected to the resection guide body 202. Theresection guide body 202 can define a resection guide opening 205 thatis configured and sized to receive at least a portion of the resectiontool 300. The resection guide opening 205 can also be configured andsized to receive a guide member as described below. The connectingmember 204 can be configured to be coupled to the tissue body 400 at thedesired resection site. For example, the connecting member 204 can beconfigured to be coupled to the tissue body 400 at a first resectionsite defined along the first resection axis 100. Thus, the connectingmember 204 can be contoured to mirror the shape of a portion of thetissue body 400 along the first resection axis 100 so that theconnecting member 204 substantially fits only over the portion of thetissue body 400 located along the first resection axis 100. Since thetissue body 400 of different patients have different shapes and sizes,the connecting member 204 can be created to fit over the desiredresection site of a specific patient. That is, the connecting member204, and thus the resection guide 200, can be patient specific.

To create a patient specific resection guide 200, a virtualthree-dimensional model of a patient's tissue body 400, such as a skull401, can be created using any suitable technology, such as x-raycomputed tomography (CT) or any technology capable of mapping the tissueportion 400. For example, a virtual three-dimensional model of thepatient's skull 401 can be created using a suitable CT machine. Theskull 401 includes the mandible 402. Thus, a virtual model of themandible 402 can also be created using the CT machine. Then, aclinician, such as a physician, asses the virtual model of the tissuebody 400 to determine what portion of the tissue body 400 should beremoved and replaced with a graft. The clinician can then determine theappropriate resection sites. For example, in the depicted tissue body400, the clinician has determined that the tissue body 400 should beresected along the resection axes 100 and 102 in order to remove adiseased tissue portion 404 of the mandible 402. As used herein, thediseased tissue portion 404 can include damaged tissue portion. However,it is envisioned that the other portions of the tissue body 400 can beremoved, and thus, the resection axes can be located at other positionsas desired. After determining the appropriate resection sites as definedby the resection axes 100 and 102, the resection guide 200 can becreated to fit over a specific resection site (as defined by, forexample, the first resection axis 100) of the patient. That is, theconnection member 204 can be shaped and sized to fit only over theresection site identified in the virtual model of the patient's tissuebody 400.

With continuing reference to FIG. 1F, after determining the resectionsites (as defined by resection axes 100 and 102), the appropriate graftsize and shape can be determined. For example, a virtual model of anappropriate graft 408 can be superimposed over tissue body portion to bereplaced, such as the diseased tissue portion 404, to determine thevirtual model of the graft 408 has the proper size and shape. In thedepicted embodiment, the virtual model of the graft 408 can include twoportions, namely: a first graft portion 409 and a second graft portion411. The first graft portion 409 and the second graft portion 411 cancooperate to define the graft 408. However, it is envisioned that thegraft 408 can be a monolithic structure or can include more twoportions. The graft 408 can be virtually designed so that it can beacquired from the same patient. That is, the graft 408 can be anautologous graft. Preferably, the first and second graft portions 409and 411 can be designed such that the bone graft 408 can be harvestedfrom a vascularized bone graft source, such as the fibula. Vascularizedbone graft is preferred because these grafts provide better blood supplythan non-vascularized bone grafts and thereby can lead to fasterhealing. However, it is contemplated that the graft 408 can be harvestedfrom a non-vascularized bone graft source.

As seen in FIG. 1G, the first graft portion 409 and the second graftportion 411 can be oriented at an oblique angle relative to each otherwhen these portions are virtually superimposed over the diseased portion404. However, in their natural state, the first graft portion 409 andthe second graft portion 411 can stem from the same graft source, andcan therefore be aligned with each other. For example, the virtualmodels of the first graft portion 409 and the second graft portion 411can be virtually removed from the virtual model of the patient'smandible 402, unfolded, and then aligned with a virtual model of a graftsource 403, such as a fibula 405, to determine the appropriate locationof the resection sites in the graft source 403. In the depictedembodiment, it can be appreciated that resections should be made in thegraft source 403, such as the fibula, along a first graft resection axis591, a second graft resection axis 593, a third graft resection axis595, and a fourth graft resection axis 597 to obtain a graft that hasthe proper size and shape to replace the resected portion, such as thediseased tissue portion 404, of the tissue body 400. In particular,according to the virtual model of that particular patient, the graftsource 403 can be resected along the graft resection axes 591 and 593 toharvest the first graft portion 408. Similarly, the graft source 403 canbe resected along resection axes 595 and 597 to harvest the second graftportion 411. The location and orientation of the graft resection axes591, 593, 595, and 597 in the virtual model of the graft source 403 canserve as guidelines to create a resection guide 50 (FIG. 1A) capable offacilitating resection along those same resection axes in the physicalgraft source 403. The resection guide 50 (FIG. 1A) can be shaped andcontoured to fit only over a portion of the graft source 403 such thatits resection guide opening (as discussed below) are aligned with thegraft resection axes 591, 593, 595, and 597.

Referring again to FIG. 1E, once the resections have been virtuallyplanned as discussed above, the resection guide 200 can be placed overthe tissue body 400 such that the resection guide opening 205 issubstantially aligned with the first resection axis 100. As discussedabove, the connection member 204 can be shaped and contoured to fit onlyover the desired resection site such that the resection guide opening205 is substantially aligned with the resection axis 100. The connectionmember 204 can be coupled to the tissue body 400 at the desiredresection site. For instance, the connecting member 204 can define oneor more holes 206 configured to receive a fastener, such as a bonescrew. One or more fasteners can be inserted through the holes 206 tocouple the resection guide 200 to the tissue body 400. The resectiontool 300 can then be inserted through the resection guide opening 205,and advanced toward the tissue body 400 to resect the tissue body 400along the first resection axis 100.

With reference to FIG. 1G, the graft 408 can replace the tissue portionremoved from the tissue body 400, such as the diseased tissue portion404 (FIG. 1E). In the depicted embodiment, the first graft portion 409and the second graft portion 411 can be positioned in the tissue body400, such that the first graft portion 409 and the second graft portion411 can together fit in the cavity 407 (FIG. 1C). The first graftportion 409 and second graft portion 411 span the cavity 407 inposterior-anterior direction and lateral-medial directioninterconnecting exposed ramus and mental protuberance of the tissue body400. Once positioned in the cavity 407, the first graft portion 409 andthe second graft portion 411 can be coupled to each other and the tissuebody 400.

Bone fixation plates 450 and anchors 470 can be used to couple the graft408 to the tissue body 400. Bone fixation plates 450 can be used tocouple to graft portions to each other and to the tissue body 400. Oneor more bone bone fixation plates 450 can be placed across the ramus oftissue body 400, the first graft portion 409, the second graft portion411, and mental protuberance of tissue body 400, then anchors 450 can beinserted through the bone fixation plates 450 and into the tissue bodyportions 400 and the graft 408 so as to couple the graft 408 to thetissue body 400. Specifically, the anchors 450 can be inserted into thepreformed tissue body bores 430 while other anchors can be insertedthrough bone plate openings and into corresponding numbers of graftbores 420 formed during resection of the graft 408.

Bone fixation plates 450 can define a plate body extending along a platelongitudinal axis. The plate body defines a plurality of openingsextending through the plate along an opening axis such that the openingaxis is perpendicular to the plate axis. The openings can be orientedsuch that the opening axis is angled in any radial direction withrespect to the plate axis. The bone plates can include a primary leg andan auxiliary leg obliquely offset relative to the primary leg. The bonefixation plate can define one or more openings in the primary leg andthe auxiliary leg. Examples suitable bone fixation plates 460 aredescribed and illustrated in U.S. patent application Ser. No. 12/963,725filed on Dec. 9, 2010 and published as US Patent Publication No.2011/0144698 on Jun. 16, 2011, the entire disclosure of which isincorporated by reference herein. Further, the bone fixation plates canbe bendable to conform to the anatomy of patient and/or structure of thegraft 408. For instance, the bone fixation plate can be bendable, orbent, along one or more portions of the bone fixation plate so that theplate axis aligned with a parallel to the surface of the tissue body 400and graft 408.

In accordance with alternate embodiments, the bone fixation plates 450can be patient specific bone plates. For instance, the tissue body 400prior to resection can be scanned, and the scanned data can be used todevelop a virtual three-dimensional model of the tissue body 400 asdescribed above. For instance, Computer Aid Design (CAD) software,running on a computer, can create a virtual three-dimensional model of abone fixation plate, based on the virtual three-dimensional model of thetissue body. The virtual three-dimensional model of the bone plate canbe manipulated or modified, for instance to include holes or openingsfor receiving anchors therein. The holes can smooth, threaded, orpartially threaded and configured to receive an a wide variety ofanchors, such as locking screws, compression screws and/or nail and anytype of fixation member or device. The plate virtual three-dimensionalmodel can be used to form a patient specific bone plate via rapidprocessing technologies described herein. For instance, via a computer,the virtual three-dimensional model of the bone plate can be used todevelop manufacturing instructions for the bone plate. The manufacturinginstructions can be transmitted to a computer in electricalcommunication with a rapid manufacturing machines. The computer receivesthe manufacturing instructions, then via a processor, the manufacturinginstructions initiate in the rapid manufacturing machine, the formationof the patient specific bone plate. The patient specific bone plate canbe formed to have a plurality of openings that are configured to alignwith the tissue body bores and graft bores. Or, as further detailedbelow, the resection guide can be manufactured to have drill guidespositioned and oriented to align with the openings formed in the patientspecific bone plate.

Referring to FIGS. 2A-B, in accordance with an embodiment, the resectionguide 50 includes the resection guide body 580 and one or more guidemembers 60. The resection guide body 580 is configured to support one ormore guide members 60, and can be wholly or partly made of a firstmaterial, such as any suitable polymeric material. For example, theresection guide body 580 can be at least partially made from the firstmaterial. Suitable polymeric materials include, but are not limited to,thermoplastics, thermosets and the like. The material at least partlyforming the resection guide body 580 (i.e., the first material) can be apolymeric material to allow the use of a rapid prototyping technologyduring the manufacturing process, thereby reducing manufacturing costand streamlining the manufacturing process. For example, the polymericresection guide body 580 can be manufactured for a specific patientusing any suitable rapid prototyping technology. In rapid prototypingmanufacturing process, a virtual design, such as a computer aided designmodel, is transformed into a physical model. Examples of rapidprototyping technologies include, but are not limited to, selectivelaser sintering (SLS), fused deposition modeling (FDM),stereolithography (SLA), and 3D printing. To take advantage of the rapidprototyping technologies, the first material can have a relatively lowhardness. For example, the first material can have a Brinell hardnessranging between about 1 HBS 10/100 and about 3 HBS 1/100. The guidemembers 60 can be entirely or partly made of a second material, such asany suitable metallic material. Suitable metallic materials include, butare not limited, to stainless steel and aluminum. The second materialcan have a Brinell hardness ranging between 10 HB and about 200 HB. Forexample, the second material can have a Brinell hardness of about 120HB. The guide members 60 can also be referred to as inserts.

With continuing reference to FIG. 2A, the resection guide body 580defines a first end 522, a second end 524 opposite to the first end 522,and a central portion 526 that is disposed between the first end 522 andthe second end 524. The first end 522 is spaced apart from the secondend 524 along the longitudinal direction 501. The resection guide body580 can define an upper body surface 581 and a lower body surface 577that is opposite the upper body surface. The upper body surface 581 canbe spaced from the lower body surface 577 along a transverse direction519. The lower body surface 577 can be configured and positioned to beplaced against the graft source 403. In the depicted embodiment, theresection guide body 580 includes a first resection guide supportingmember 502, a second resection guide supporting member 542, a thirdresection guide supporting member 562, and a fourth resection guidesupporting member 582. It is envisioned, however, that the resectionguide body 580 can include more or fewer resection guide supportingmembers. The first resection guide supporting member 502 can be disposedat or near the first end 522 of the resection guide body 580. The secondand third resection guide supporting members 542 and 562 can be disposedat or near the central portion 526 of the resection guide body 580. Thefourth resection guide supporting member 582 can be disposed at or nearthe second end 524 of the resection guide body 580.

With continuing reference to FIG. 2A, the resection guide body 580 caninclude a plurality of connecting members that are configured to couplethe resection guide supporting members 502, 542, 562, and 582 to oneanother. In the depicted embodiment, the resection guide body 580includes a first connecting member 520, a second connecting member 550,and a third connecting member 570 that are separated from one anotheralong the longitudinal direction 501. The first connecting member 520can couple the first resection guide supporting member 562 with thesecond resection guide supporting member 542 such that the firstresection guide supporting member 562 and the second resection guidesupporting member 542 are spaced apart from each other a predetermineddistance along the longitudinal direction 501. A second connectingmember 550 can couple the second resection guide supporting member 542with the third resection guide supporting member 562. A third connectingmember 570 can couple the third resection guide supporting member 562with the fourth resection guide supporting member 582 such that thethird resection guide supporting member 562 and the fourth resectionguide supporting member 582 are spaced apart from each other apredetermined distance along the longitudinal direction 501. Thecross-section of the connecting members 520, 550, and 570 can have anysuitable shape. For example, the cross-section of one or more connectingmembers 520, 550, or 570 can be substantially arc-shaped. It isenvisioned, however, that the cross-section of one or more connectingmembers 520, 550 or 570 can have other suitable shapes, such ascircular, oval, rectangular, polygonal, etc. The resection guidesupporting members 502, 642, 562, 582 and the connecting members 520,550, and 570 cooperate to define the resection guide body 580.

With continuing reference to FIG. 2B, the first resection guidesupporting member 502 can include a first left side wall 503, a firstright side wall 505 opposite to the first left side wall 503, a firstfront wall 506, and a first rear wall 507 opposite to the first frontwall 506. The first front wall 506 can interconnect the first left sidewall 503 and the first right side wall 505. The first rear wall 507 caninterconnect the first left side wall 503 and the first right side wall505. The first left side wall 503 can interconnect the first front wall506 and the first rear wall 507. The first right side wall 505 caninterconnect the first front wall 506 and the first rear wall 507.Furthermore, at least a portion of the first right side wall 505 isdirectly or indirectly connected to the first connecting member 520. Thefirst left wall 503, first right side wall 505, first front wall 506,and first rear wall 507 cooperate so as to define a first upper surface512. Moreover, the first left wall 503, first right side wall 505, firstfront wall 506, and first rear wall 507 cooperate so as to define afirst lower surface 514.

With continuing reference to FIG. 2B, the first left wall 503, firstright side wall 505, first front wall 506, and first rear wall 507 cancooperate so as to define a substantially or completely enclosed firstinner surface 518. Alternatively, the first inner surface 518 is not asubstantially or completely enclosed. The first inner surface 518 of theresection guide supporting member 502 defines a first resection guideopening 504 that is configured and sized to receive at least a portionof a guide member 60 as discussed in detail below. The first innersurface 518 is disposed between the first upper surface 512 and thefirst lower surface 514. The first resection guide opening 504 canextend through the first upper surface 512 and the first lower surface514 along the transverse direction 519 that is substantiallyperpendicular to the longitudinal direction 501. In the depictedembodiment, the resection guide opening 504 can have a substantiallyrectangular cross-section, and can be elongate, for example, along alateral direction 517 that is perpendicular to the longitudinaldirection 501. In other words, the resection guide opening 504 can beelongate, for example, along a direction from the first front wall 506toward the first rear wall 507.

Continuing with FIG. 2C, the second and third resection guide supportingmembers 542 and 526 can be disposed at the central portion 526 of theresection guide body 580. Each of the second and third resection guidesupporting members 542 and 562 defines a corresponding resection guideopening 544 and 564. The second and third resection guide supportingmembers 542 and 562 can be oriented relative to each other so that theirrespective resection guide openings 544 and 564 intersect each other.The second and third resection guide supporting members 542 and 562 canalso intersect each other.

With continuing reference to FIG. 2C, the second resection guidesupporting member 542 can include a second left side wall 543, a secondright side wall 545 opposite to the second left side wall 543, a secondfront wall 546, and a second rear wall 547 opposite to the second frontwall 546. The second front wall 546 can interconnect the second leftside wall 543 and the second right side wall 545. The second rear wall547 can interconnect the second left side wall 543 and the second rightside wall 545. The second left side wall 543 can interconnect the secondfront wall 546 and the second rear wall 547. The second right side wall545 can interconnect the first front wall 546 and the second rear wall547. Furthermore, at least a portion of the second left side wall 543can be directly or indirectly connected to the first connecting member520. At least a portion of the second right side wall 545 can bedirectly or indirectly connected to the second connecting member 550.The second left wall 543, second right side wall 545, second front wall546, and second rear wall 547 can cooperate so as to define a secondupper surface 552. Moreover, the second left wall 543, second right sidewall 545, second front wall 546, and second rear wall 547 can cooperateso as to define a second lower surface 554.

Continuing with FIG. 2C, the second left wall 543, second right sidewall 545, second front wall 546, and second rear wall 547 can cooperateso as to define a substantially enclosed second inner surface 558.Alternatively, the second inner surface 558 is not a substantially orcompletely enclosed. The second inner surface 558 of the secondresection guide supporting member 542 can define the second resectionguide opening 544 that is configured and sized to receive at least aportion of the guide member 60 or any other suitable guide member asdiscussed in detail below. The second resection guide opening 544 canextend through the second upper surface 552 and the second lower surface554 along the transverse direction 519. In the depicted embodiment, theresection guide opening 544 can have a substantially rectangularcross-section, and can be elongate, for example, along a first angleddirection 549 that defines an oblique angle relative to the longitudinaldirection 501. The first angled direction 549 can also define an obliqueangle relative to the lateral direction 517. The second resection guideopening 544 can be elongate, for example, along a direction from thesecond front wall 546 toward the first rear wall 547.

Continuing with FIG. 2C, the third resection guide supporting member 562can include a third left side wall 563, a third right side wall 565opposite to the third left side wall 563, a third front wall 566, and athird rear wall 567 opposite to the third front wall 566. The thirdfront wall 566 can interconnect the third left side wall 563 and thethird right side wall 565. The third rear wall 567 can interconnect thethird left side wall 563 and the third right side wall 565. The thirdleft side wall 563 can interconnect the third front wall 566 and thethird rear wall 567. The third right side wall 565 can interconnect thethird front wall 566 and the third rear wall 567. Furthermore, at leasta portion of the third left side wall 563 can be directly or indirectlyconnected to the second connecting member 550. At least a portion of thethird right side wall 565 can be directly or indirectly connected to thethird connecting member 570. The third left wall 563, third right sidewall 565, third front wall 566, and third rear wall 566 can cooperate soas to define a third upper surface 572. Moreover, the third left wall563, third right side wall 565, third front wall 566, and third rearwall 56 can cooperate so as to define a third lower surface 574.

Continuing with FIG. 2C, the third left wall 563, third right side wall565, third front wall 566, and third rear wall 567 can cooperate so asto define a substantially enclosed third inner surface 568.Alternatively, the third inner surface 568 is not a substantiallyenclosed. The third inner surface 568 can define the third resectionguide opening 564 that is configured and sized to receive at least aportion of the guide member 60 or any other suitable guide member asdiscussed in detail below. The third resection guide opening 564 canextend through the third upper surface 572 and the third lower surface574 along the transverse direction 519. In the depicted embodiment, thethird resection guide opening 564 can have a substantially rectangularcross-section, and can be elongate, for example, along a second angleddirection 579 that defines an oblique angle relative to the longitudinaldirection 501. The second angled direction 579 can also define anoblique angle relative to the longitudinal lateral direction 517. Thethird resection guide opening 564 can be elongate, for example, along adirection from the third front wall 566 toward the first rear wall 567.

Referring to FIG. 2D, the fourth resection guide supporting member 582can be substantially similar to the first resection guide supportingmember 502. The fourth resection guide supporting member 582 can includea fourth left side wall 583, a fourth right side wall 585 opposite tothe fourth left side wall 583, a fourth front wall 586, and a fourthrear wall 587 opposite to the fourth front wall 586. The fourth frontwall 586 can interconnect the fourth left side wall 583 and the fourthright side wall 585. The fourth rear wall 587 can interconnect thefourth left side wall 583 and the fourth right side wall 585. The fourthleft side wall 583 can interconnect the fourth front wall 586 and thefourth rear wall 587. The fourth right side wall 585 can interconnectthe fourth front wall 586 and the fourth rear wall 587. Furthermore, atleast a portion of the fourth left side wall 583 can be directly orindirectly connected to the third connecting member 570. The fourth leftwall 583, fourth right side wall 585, fourth front wall 586, and fourthrear wall 586 can cooperate so as to define a fourth upper surface 592.Moreover, the fourth left wall 583, fourth right side wall 585, fourthfront wall 586, and fourth rear wall 586 can cooperate so as to define afourth lower surface 594.

With continuing reference to FIG. 2D, the fourth left wall 583, fourthright side wall 585, fourth front wall 586, and fourth rear wall 586 cancooperate so as to define a substantially or completely enclosed fourthinner surface 598. Alternatively, the fourth inner surface 598 is not asubstantially or completely enclosed. The fourth inner surface 598 candefine a fourth resection guide opening 584 that is configured and sizedto receive at least a portion of the guide member 60 or any othersuitable guide member as discussed in detail below. The fourth resectionguide opening 584 can extend through the first upper surface 592 and thefirst lower surface 594 along the transverse direction 519. In thedepicted embodiment, the resection guide opening 584 can have asubstantially rectangular cross-section, and can be elongate, forexample, along the lateral direction 517 that is perpendicular to thelongitudinal direction 501. The resection guide opening 584 can beelongate, for example, along a direction from the first front wall 586toward the first rear wall 587.

With reference to FIG. 2E, the first lower surface 514 can include afirst connecting portion 516 contoured and configured to receive aportion of the tissue body 400 so as to allow the resection guide body580 to be positioned on a portion of the tissue body 400. The firstconnecting portion 516 can have a substantially concave shape. Thesecond lower surface 554 can include a second connecting portion 566contoured and configured to receive a portion of the tissue body 400 soas to allow the resection guide body 580 to be positioned on at least aportion of the tissue body 400. The second connecting portion 566 canhave a substantially concave shape. The third lower surface 574 caninclude a third connecting portion 556 contoured and configured toreceive a portion of the tissue body 400 so as to allow the resectionguide body 580 to be positioned on at least a portion of the tissue body400. The third connecting portion 556 can have a substantially concaveshape. The fourth lower surface 594 can include a fourth connectingportion 596 contoured and configured to receive a portion of the tissuebody so as to allow the resection guide body 580 to be positioned on aportion of the tissue body. The fourth connecting portion 596 can have asubstantially concave shape.

Referring to FIGS. 3 and 4, the guide member 60 is configured to guidethe resection tool 300 to a desired surgical site in order to make anaccurate and precise cut on the tissue body 400. In the depictedembodiment, at least a portion of the guide member 60 is configured andsized to be removably inserted in each of the resection guide openings504, 544, 564, and 584. For example, the guide member 60 can beconfigured to be at least partially inserted in at least one of thefirst resection guide opening 504 or the second resection guide opening544. At least a portion of the guide member 60 can be removably disposedin the first resection guide opening 504 or the second resection guideopening 544. The guide member 60 can be configured to be selectivelyinserted into each of the first, second, third, and fourth resectionguide openings 504, 544, 564, and 584 so as to guide the resection tool300 along the graft resection axis 603. Alternatively, the guide member60 is configured and sized to be removably inserted in some but not allof the resection guide openings 504, 544, 564, and 584.

The guide member 60 can be wholly or partly made of a second materialthat is different than the first material discussed above. For example,the guide member 60 can be at least partially made of the secondmaterial. The second material can be harder than the first material. Thesecond material can be a cut resistant material, such as a metallicmaterial or a ceramic material. As used herein, the term cut resistantmaterial refers to a material that minimizes the wear of the guidemember 60 caused by the friction exerted by the resection tool (e.g., aresection tool capable of resecting tissue, such as bone) on the guidemember 60 when the resection tool 300 contacts the guide member 106. Itis important to employ a cut resistant material because the wear of theguide member 106 may reduce the accuracy of the resection guide 50 andproduce wear debris. Wear debris stemming from the resection guide 50could be detrimental to the long-term efficacy of the bone graft. Thesecond material can be different from the first material, which at leastpartly forms the resection guide supporting members 502, 542, 562, 582.The hardness of the second material can be greater than the hardness ofthe first material. For instance, the first material has a firsthardness, the second material has a second hardness, and the secondhardness is greater than the first hardness. The first material does notnecessarily have to be a cut resistant material to minimize costs andstreamline the manufacturing process as discussed above. In someembodiments, the second material can have a Brinell hardness that rangesbetween about 10 HB and about 200 HB. For example, the second materialcan have a Brinell hardness of about 120 HB. The hardness ranges andvalues described above are important because a guide member 60 wholly orpartly made of a material with these hardness values minimizes the wearof the guide member 60 during use, thereby extending the life of theresection guide 50. The second material can be at least partially madefrom a laser-sintered metallic material. The second material can be madeusing a direct metal laser sintering process. As discussed above, theresection guide body 580 can be wholly or partly made of a firstmaterial that has a Brinell hardness that ranges between about 1 HBS10/100 and about 3 HBS 10/100.

With reference to FIGS. 3 and 4, the guide member 60 includes a guidemember body 602. The guide member body 602 can be a monolithic (i.e.,one-piece) structure or a structure composed of multiple connectedparts. In the depicted embodiment, the guide member body 602 can includea guiding left wall 604, a guiding right wall 606 opposite the guidingleft wall 604, a guiding front wall 608, and a guiding rear wall 610opposite to the guiding front wall 608. In other words, the guide memberbody 602 can define the front wall 608, the rear wall 610 opposite thefront wall 608, and a pair of side walls 604 and 606 that extend betweenthe front and rear walls 608 and 610. The front wall 608, the rear wall610, and the side walls 606 and 604 define the guide member opening 618.The guiding front wall 608 can be spaced apart from the guiding rearwall 610 along a transverse direction 614. The guiding left wall 604 canbe spaced apart from the guiding right wall 606 along a longitudinaldirection 601. The guiding left wall 604 can interconnect the guidingfront wall 608 and the guiding rear wall 610. The guiding right wall 606can interconnect the guiding front wall 608 and the guiding rear wall610. The guiding front wall 608 can interconnect the guiding left wall604 and the guiding right wall 606. The guiding rear wall 610 caninterconnect the guiding left wall 604 and the guiding right wall 606.

With reference to FIGS. 3 and 4, the guiding left wall 604, guidingright wall 606, guiding front wall 608, and guiding rear wall 610 cancooperate so as to define a guiding upper surface 612. Furthermore, theguiding left wall 604, guiding right wall 606, guiding front wall 608,and guiding rear wall 610 can cooperate so as to define a guiding lowersurface 614. Moreover, the guiding left wall 604, guiding right wall606, guiding front wall 608, and guiding rear wall 610 can cooperate soto define a guiding inner surface 616. The guiding inner surface 616 candefine a guide member opening 618 that can extend through the guidingupper surface 612 and the guiding lower surface 614 along the lateraldirection 619. Thus, the guide member 60 can define the guide memberopening 618 that extends through the guide member body 602. The guidemember opening can be elongate along a graft resection axis 603. Theguide member opening 618 is configured and sized to receive at least aportion of the resection tool 300 such that the guide member 60 guides amovement of the resection tool 300 along the graft resection axis 603when the resection tool 300 is received in the guide member opening 618.The side walls 604 and 606 can be elongate along the graft resectionaxis 603.

With reference to FIGS. 3 and 4, the guide member 60 further includes atleast one tab 620 or 622 that protrudes from the guide member body 602.Each of the tabs 620 and 622 is configured to help retain the guidemember 60 in the corresponding resection guide supporting members 502,542, 562, and 582 as discussed in detail below. In the depictedembodiment, the guide member 60 includes a first tab 620 that can bedirectly or indirectly connected to the guiding front wall 608, and asecond tab 622 that can be directly or indirectly connected to theguiding rear wall 610. The first tab 620 can be at least partiallydisposed on top of the guiding front wall 608. The second tab 622 can beat least partially disposed on top of the guiding rear wall 610. In someembodiments, the first tab 620 is cantilevered from guiding front wall608, and the second tab 622 is cantilevered from the guiding rear wall610. Thus, at least one of the tab 620 or the tab 622 can becantilevered from the guide member body 602.

When the guide member body 602 is inserted in the resection guideopening 504, 544, 564, or 584, the first tab 620 and second tab 622 areeach configured to abut a portion of the upper surface of thecorresponding resection guide supporting member 502, 542, 562, or 582 tothereby retain the guide member 60 in the resection guide body 580. Forexample, the guide member body 602 can be removably inserted in theresection guide opening 504 of the resection guide supporting member502. When the guide member body 602 is disposed in the resection guideopening 504, the first and second tabs 620 and 622 abut the uppersurface 512 of the resection guide body 504 to thereby retain the guidemember 60 in the resection guide supporting member 502. At least one ofthe tab 620 or the tab 622 can be configured to abut at least a portionof the upper body surface 581 when the guide member body 602 is fullyseated into the first resection guide opening 504 or the secondresection guide opening 544. The guide member 60 can include the secondtab 622 that is cantilevered from the guide member body 602. The secondtab 622 can be configured to abut at least a portion of the upper bodysurface 581 when the guide member body 602 is fully seated in the firstresection guide opening 504 or the second resection guide opening 544.The first tab 620 can protrude from the front wall 608, and the secondtab 622 can protrude from the rear wall 606.

With reference to FIG. 5, a guide member 70 is configured to besimultaneously disposed in the resection guide supporting members 542and 562. The guide member 70 is substantially similar to the guidemember 60, except that the guide member 70 includes two guide memberbodies instead of one guide member body. The guide member 70 includes afirst guide member body 702 and a second guide member body 703 thatintersect each other. The first and second guide member bodies 702 and703 are oriented such that they are configured to be disposedsimultaneously in the resection guide openings 544 and 564. For example,the first guide member body 702 can be disposed to be removably insertedin the resection guide opening 544, while the second guide member body703 can be configured to be removably disposed in the resection guideopening 564. Each of the guide member bodies 702 and 703 can define arespective guide member opening 718 and 719 that is configured and sizedto receive at least a portion of the resection tool 300 to thereby guidethe movement of the resection tool 300 toward the tissue body 400. Theguide member openings 718 and 719 can intersect each other. The guidemember 70 can further include at least one tab 720 that protrudes fromthe respective guide member bodies 702 and 703. In the depictedembodiment, the guide member body 702 can include a first tab 720 and asecond tab 722. Similarly, the guide member body 703 can include a firsttab 721 and a second tab 723. The guide member 70 can be wholly orpartly made of the second material discussed above. The second materialcan be a cut resistant material, such as a metallic material or aceramic material.

In operation, the user positions the resection guide supporting members502, 542, 562, and 582 in the desired location adjacent to the tissuebody 400 (FIG. 1A). Then, the guide member 60 is inserted in a resectionguide opening 504, 544, 564 or 584 to couple the guide member 60 to thecorresponding the resection guide supporting member 502, 542, 562, or582. Next, at least a portion of the resection tool 300 is insertedthrough the guide member opening 618. The resection tool 300 is advancetoward the tissue body 400 to make a precise cut of the tissue body 400.The guide member 60 can then be removed from the resection guide bodyand inserted in another resection guide body. In addition, the user canplace guide member 70 in the resection guide openings 544 and 564. Theresection tool 300 can then be inserted and advanced through the guidemember opening 718 to make a first cut on the tissue body 400. Moreover,the resection tool 300 can also be inserted in the guide member opening719 to make another cut on the tissue body 400.

With reference to FIG. 6A, in accordance with an alternate embodiment,the resection guide 50 can include guide members 800 formed by aplurality of discrete guiding components 802, such as discrete guidinginserts. As used herein, the term “discrete components” refers, forexample, to unconnected elements. Like in other embodiments, thediscrete guiding components 802 can be entirely or partly made from acut resistant material (e.g., the second material discussed above). Thediscrete guiding components 802 can be made from the second material.The discrete guiding components 802 can be attached to the first innersurface 518, second inner surface 558, third inner surface 568, andfourth inner surface 598. For instance, when the discrete guidingcomponents 802 are attached to the first inner surface 518, second innersurface 558, third inner surface 568, and fourth inner surface 598, thediscrete guiding components 802 can cooperate to define a guide memberopening 818 that is configured and sized to receive at least a portionof the resection tool 300 to thereby guide the movement of the resectiontool 300 toward the tissue body 400. The resection guide body 580 canincludes the first and second inner surfaces 518, 558 that at leastpartially define the first and second resection guide openings 504, 544,respectively, and guide member 60 is segmented so as to define aplurality of discrete guiding components 802 that are configured to bemounted to at least one of the first or second inner surfaces 518, 558.

With continuing reference to FIG. 6A, the discrete guiding component 802can be attached to the resection guide supporting members 502, 542, 562,582 along the respective first inner surface 518, second inner surface558, third inner surface 568, and fourth inner surface 598. In thedepicted embodiment, the discrete guiding components 802 can include atleast one guiding wall 804. The guiding wall 804 can have asubstantially planar configuration.

With continuing reference to FIG. 6B, any of the discrete guidingcomponents 802 described above can be attached to the first innersurface 518, second inner surface 558, third inner surface 568, orfourth inner surface 598 by any suitable apparatus, connection, ormechanism. For example, a press-fit connection 820 can be used to attacha discrete component 802 to the first inner surface 518 (or any otherinner surface) of the resection guide supporting member 502 (or anyother resection guide body). In the interest of brevity, the presentdisclosure describes the connection between the discrete guide member802 and the first resection guide supporting member 502; however, thediscrete guide member 802 can be connected to any of the resection guidesupporting members as described below. The press-fit connection 820includes a first engagement member 822 and a second engagement member819. The discrete guiding components 802 and the respective first orsecond inner surface 518 or 558 defines complementary engagement members822 and 819 that are configured to mate so as to attach the discreteguiding components 802 to the respective inner surface 518 and 558. Thefirst engagement member 822 can be part of the discrete guidingcomponent 802, and the second engagement member 819 can be part of theresection guide supporting member 502 (or any other resection guide bodyof the resection guide body 580). The first engagement member 822 isconfigured to engage the second engagement member 819 so as to connectthe discrete guide member 802 to the resection guide supporting member502. The second engagement member 819 can include a groove 824 thatextends into the inner surface 518 and is configured to receive at leasta portion of the engagement member 822. Thus, the inner surface 518 (or558 or any other inner surface of the resection guide body 580) candefine the groove 824 that is configured to receive the tongue 830. Thetongue 830 can be tapered so as to so as to be press-fit within therespective groove 824.

With continuing reference to FIG. 6B, as discussed above, each discreteguiding component 802 includes at least one guiding wall 804. Theguiding wall 804 can define an outer surface 810, an inner surface 812opposite to the outer surface 810, an upper surface 814, a bottomsurface 816 opposite the upper surface 814, a first sidewall 826, and asecond sidewall 828 opposite the first sidewall 826. The outer surface810 is spaced from the inner surface 812 along a lateral direction 829.The upper surface 814 is spaced from the bottom surface 816 along atransverse direction 825 that is substantially perpendicular to thelateral direction 829. The first side wall 826 is spaced from the secondsidewall 828 along a longitudinal direction 827 that is substantiallyperpendicular to the lateral direction 829. The longitudinal direction827 can also be substantially perpendicular to the transverse direction825.

With continuing reference to FIG. 6B, the first engagement member 822can be a protrusion 823 that protrudes from the guiding wall 804. In thedepicted embodiment, the first engagement member 822 can protrude fromthe guiding wall 804 in a direction away from the inner surface 812along the lateral direction 829. The first engagement member 822 iscoupled to the inner surface 812, and can be elongate in a directionfrom the upper surface 814 toward the bottom surface 816. In thedepicted embodiment, the first engagement member 822 can be elongatealong the transverse direction 825. The first engagement member 822 canbe monolithically formed with the guiding wall 804, and can be shaped asa column. Furthermore, the first engagement member 822 of each of thediscrete guiding components 802 can include a tongue 830 that defines afirst sidewall 832 and a second sidewall 834 opposite to the firstsidewall 832. The first sidewall 832 is spaced from the second sidewall834 along the longitudinal direction 827. The tongue 830 includes anupper portion 836 and a lower portion 838. The upper portion 836 islocated closer to the upper surface 814 than the lower portion 838. Thelower portion 838 is located closer to the bottom surface 816 than theupper portion 836. The tongue 830 has a width defined from the firstsidewall 834 to the second sidewall 832. The lower portion 838 can havea tapered configuration such that the width of the tongue 830 decreasesin a direction from upper surface 814 toward the bottom surface 816.(i.e., downwardly). The tapered configuration of the lower portion 838facilitates insertion of the first engagement member 822 into the groove824.

With continuing reference to FIG. 6B, the first engagement member 822further includes one or more projections 840, such as barbs, thatprotrude from the tongue 830. In the depicted embodiment, a plurality ofprojections 840 are disposed along the first and second sidewalls 832and 834 at the upper portion 836. Alternatively, the surfaces definingthe groove 824 can include protrusions that are configured to bereceived inside recesses defined by the first engagement member 822.

As discussed above, the second engagement member 819 can be the groove824 that is configured and sized to receive the guiding connectionmember 822. The groove 824 can extends into the first inner surface 518and is configured to receive at least a portion of the first engagementmember 822. The mounting channel 822 can be defined by a first sidewall842, a second sidewall 844 opposite to the first sidewall 842, and anend wall 846. The first sidewall 842 can be spaced from the secondsidewall 844 along the longitudinal direction 827. In addition, themounting channel 822 can define an open end 848 to facilitate insertionof the first engagement member 822 in the mounting channel 822. The openend 848 is located along the upper surface 512 of the resection guidesupporting member 502 (or other upper surface of another resection guidebody). The mounting channel 822 can define another open end along firstlower surface 514 (or other lower surface of another resection guidebody). Moreover, the mounting channel 822 can be elongate in a directionfrom the upper surface 512 toward the lower surface 514 (i.e., along thetransverse direction 825). The width of first engagement member 822 atthe upper portion 836 is sufficiently large so that the projections 840contact at least one of the first sidewall 842 or the second sidewall844 when the upper portion 836 is at least partially disposed in themounting channel 822 to thereby secure the first engagement member 822to the second engagement member 819. The secure connection between thefirst engagement member 822 and the second engagement member 819 in turncauses the discrete guiding component 802 to be connected to theresection guide supporting member 502.

With continuing reference to FIG. 6B, the discrete guiding component 802can be coupled to the resection guide supporting member 502 (or anyother resection guide supporting member) by inserting the firstengagement member 822 into the groove 824. The lower portion 838 can beinserted first, and then the first engagement member 822 can be advancedfurther into the groove 824 until at least one projection 840 contactsthe first sidewall 842 or second sidewall 844 that define the mountingchannel 822. The friction created between the projections 840 and atleast one of the first sidewall 842 or second sidewall 844 when at leasta section of the upper portion 836 is disposed in the mounting channel822 causes the discrete guiding component 802 to be secured to theresection guide supporting member 502 (or any other resection guidesupporting member).

With reference to FIG. 7, a resection guide 90 is substantially similarto the resection guide 50 shown in FIG. 2A. However, in this embodiment,the resection guide support 580 is wholly or partly made of a lasersintered polymer material, and the guide members 60 a and 70 a areentirely or partly made of a laser sintered metallic material. Theresection guide support 580 can be manufactured using a direct metallaser sintering (DMLS) process, whereas the guide members 60 a and 70 acan be manufactured using stereolithography (commonly referred to asSLA). The DMLS and SLA processes allow 3D CAD drawings to be turned intophysical objects, thereby facilitating and streamlining themanufacturing process. The guide members 60 a are substantially similarto the guide member 60 shown in FIG. 13. However, the guide member 60 adoes not necessarily include supporting members and are not necessarilyconfigured to be removed from the resection guide supporting members 502and 582. For example, the guide members 60 a can be press fitted intothe resection guide supporting members 502 and 582. The guide member 70a is substantially similar to the guide member 70 shown in FIG. 5.However, the guide member 70 a does not necessarily include supportingmembers and are not necessarily configured to be removed from theresection guide bodies 542 and 562. For instance, the guide member 70 acan be press fitted into the resection guide bodies 542 and 562. As withthe other guide members described above, the guide members 60 a and 70 aare wholly or partly made from a cut resistant material, such as ametallic material.

With reference to FIG. 8, a resection guide 1000 is substantiallysimilar to the resection guide 50 shown in FIG. 2A, but does notnecessarily include guide members. The resection guide 1000 is entirelyor partly made of a cut resistant material, such as a metallic material.For instance, the entire resection guide 100 can be manufactured from ametallic material using a direct metal laser sintering (DMLS) process.As discussed above, in the DMLS process, 3-D CAD drawings can be turnedinto physical objects.

With continuing reference to FIG. 8, the resection guide 1000 caninclude metallic resection guide body 1080. The resection guide body1080 can define an upper body surface 1081 and a lower body surface 1077opposite the upper body surface 1081. The lower body surface 1077 can beconfigured to face the graft source 403. The resection guide body 1080can define a first and second resection guide openings 1004 and 1044that are spaced from each other and extend from the lower body surface1077 through the upper body surface 1081. The first and second resectionguide openings 1004 and 1044 can define respective first and secondgraft resection axes 1091 and 1093 that are configured to receive aportion of the resection tool 300 and guide the resection tool 300 alongthe respective first and second resection guide openings 1004 and 1044so as to resect a graft portion from the graft source 403. The resectionguide body 1080 can define a third and fourth resection guide openings1064 and 1084 that are spaced from each other and extend from the lowerbody surface 1077 through the upper body surface 1081. The third andfourth resection guide openings 1064 and 1084 can define respectivethird and fourth graft resection axes 1095 and 1097 that are configuredto receive a portion of the resection tool 300 and guide the resectiontool 300 along the respective first and second resection guide openings1064 and 1084 so as to resect a graft portion from the graft source 403.The resection guide body 1080 can define first and second inner surfaces1018 and 1058 that at least partially define the first and secondresection guide openings 1004 and 1044. The first and second innersurfaces 1018 and 1058 are configured to contact the resection tool 300as the resection tool 300 is guided along the respective first andsecond graft resection axes 1091 and 1093. The resection guide body 1080can define third and fourth inner surfaces 1068 and 1098 that at leastpartially define the first and second resection guide openings 1064 and1084. The third and fourth inner surfaces 1068 and 1098 are configuredto contact the resection tool 300 as the resection tool 300 is guidedalong the respective first and second graft resection axes 1095 and1097. The openings 1004, 1044, 1064, and 1084 can be devoid of insertsthat are discrete with the resection guide body 1080. The metallicresection guide body 1080 can be laser-sintered. The first and secondaxis 1091 and 1039 can be angularly offset with respect to each other.The third and fourth exes 1095 and 1097 can be angularly offset withrespect to each other. The resection guide body 1080 can be made from ametallic material that has a Brinell hardness ranging between about 10HBS and about 200 HBS. For example, the resection guide body 1080 can bemade from a metallic material that has a Brinell hardness of about 120HB.

Referring to FIG. 9A, the resection guide 110 includes a resection guidebody 580 that defines one or more resection guides and/or resectionsupport members as described above. In accordance with the alternativeembodiment, the resection guide 110 can include and one or more drillingguide members 900. The resection guide 110 can be a patient specificresection guide, designed and manufactured as described above in otherembodiments of the present disclosure. The resection guide 110 isconfigured to be placed on the graft source 403 such that the resectionguide members are in alignment with resection axes (FIG. 1A), while thedrilling guide members 900 align with desired anchor locations on thegraft source 403. Anchor locations are locations on the graft source 403that are suitable for securing a bone fixation plate thereto when graft408 is positioned on the tissue body 400. As discussed above, theresection guide 110 is patient specific; the resection guide membersguide a cutting tool 300 to the graft source 403 so as to cut patientspecific graft portions 409 and 411, and the drilling guide members 900guide a drill bit 310 to the graft source 403 to form patient specificgraft bores 420 at the desired anchor locations. The graft bores 420 areformed in the graft source 403 during resection so that when the graft408 is positioned in the cavity 407, and the fixation plate 450 isplaced against the graft 408 and tissue body 400, one or more of graftbores 420 are aligned with a corresponding number of holes in thefixation plate 450. An anchor 460 can be interested through the hole inthe bone fixation plate 450 into the aligned graft bore 420. It shouldbe appreciated that the graft bores 420 can be formed at any locationthe graft source 403 depending on the configuration of the resectionguide and drill guide members 900, as further described below.

Referring to FIGS. 9A and 9B, in accordance with an alternativeembodiment, the resection guide body 580 extends between a first end 522and a second end 916 spaced from the first end 522 along thelongitudinal direction 501. The resection guide body 580 defines anupper body surface 581 and a lower body surface 577 that is opposite toand spaced from the upper body surface 581 along the transversedirection 519. The lower body surface 577 is configured to be placedagainst the graft source 403. The resection guide 110 defines alongitudinal central axis 509 that is aligned with and extends along thelongitudinal direction 501, a lateral axis 510 that is perpendicular tothe central axis 509, and a transverse axis 511 that is perpendicular tothe lateral axis 510 and the central axis 509. The lateral andtransverse axes 510 and 511 may considered first and second radial axes509 and 510, for instance, when the resection guide body 580 has curvedprofile as illustrated in FIGS. 9A and 10A-11B. The central axis 509,lateral axis 510, and transverse axis 511 intersect at a point 806.

It should be appreciated that the resection guide axes 509, 510 and 511correspond to and are aligned with graft source axes 459, 460, and 461.For instance, the graft source 403 can define a central axis 459extending along a length of the graft source 403, a lateral axis 460that is perpendicular to the central axis 459, and a transverse axis 461that is perpendicular to the lateral axis 460 and the central axis 459.The graft source lateral axis 460 and graft source transverse axis 461can be defined as perpendicular first and second radial axes 460 and461.

Further, the resection guide body 580 includes a first resection guidesupporting member 502, a second resection guide supporting member 542, athird resection guide supporting member 562, and a fourth resectionguide supporting member 582 configured similar to the resection guide 60described above. The resection guide body 580 also includes a pluralityof connection members 520, 550, 570 each of which couple respectiveadjacent resection guide supporting members 502, 542, 562, and 582together. A resection guide member, such as resection guide members 60and/or 80, can be disposed in the opening of the resection guide supportmember 502, 542, 562, and 582. The resection guide body 580 can furtherdefine one or more holes 587 that are configured to receive therethrougha fastener, such as a bone screw, used to couple the guide body 580 tothe graft source 403 during resection of graft portions 409 and 411 andformation of the graft bores 420. Further, the resection guide body 580can be a monolithic metallic material or polymeric material, similar tothe embodiment shown in FIG. 8, such that the resection guide supportmembers are monolithic with the resection guide body 580 and define theresection guide members 60.

In accordance with the alternative embodiment, the resection guide body580 defines a flange 917 disposed at the second end 916 of the resectionguide body 580. The flange 917 is configured to guide a cutting tooltoward the graft source 403. The resection guide body 580 illustrated inFIGS. 9A-11B include a fourth connection member 590 the couplesresection guide support member 582 to the flange 917 such that theflange 917 is spaced from the resection guide support member 582 alongthe longitudinal direction 509. The flange 917 protrudes from the bodysurface 581 along the transverse direction 519 and the lateral direction517. The flange 917 includes a first surface 918 and a second surface919 spaced from the first surface 918. The first surface 918 defines aguide surface, which is configured to guide a cutting tool toward thegraft source 403. It should be appreciated that the flange 917 can beoriented relative resection guide body 580 such that guide surface 918can guide a resection tool 300 along a desired resection axis, such asfirst resection 591 (FIG. 1A). For instance, the flange 917 can beoriented on the resection guide body 580 such that the guide surface 918is angularly offset relative to the lateral axis 510 (FIG. 9A) so as todefine a flange angle it between the surface 918 and central axis 509.The flange angle it can be oblique, for instance acute or obtuse,depending on the desired graft 408 configuration. For instance, theflange 917 can be oriented on the resection guide body 580 such that theguide surface 918 is perpendicular to the central axis 509.

The resection guide 110 can also include a support member 920 extendingfrom the resection guide body 580 and configured to support theresection guide 110 on the patient. The support member 920 includes asupport plate 922 and a beam 928 connecting the plate 922 to theresection guide body 580. The plate 922 defines a tissue contact surface926 and plate surface 924 opposite the tissue contact surface 926. Thebeam 928 defines a first end 928 a and a terminal end 925 b spaced fromthe first end 928 a. The beam first end 925 a is coupled to or integralwith the connection member 590 on the resection guide body 580, whilebeam terminal end 925 b is coupled to or integral with the plate 922.The beam 928 can arch along the transverse direction 519 over flange917. The support member 920 can be a monolithic, for instance the beam928 and plate 922 are monolithic. The support member 920 can be coupledto the support guide body 580 or monolithic with support guide body 580.The resection guide 110 can include one or more support members 920, forinstance a first support member (not shown) and second support member(not shown) disposed at the first end 522 of the resection guide body580. In other embodiments, the support member 920 can one include ormore multiple beams 928 each having a support plates disposed on theterminal ends of the beams. Further, the support member can define oneor more beams with a bulb or an enlarged portion disposed a terminal endof the beam.

The drilling guide members 900 are configured to receive and guide atool, such as a drill bit, toward to the graft source 403 to form thegraft bores 420 (FIG. 10A) in the graft source 403. Referring to FIGS.9B-11B, the resection guide 110 includes at least one drill guide member900 disposed along the resection guide body 580. At least one (aplurality is illustrated) drilling guide member 900 is disposed on oneor more of the connection members 520, 550, 570 and 590. For instance,in the embodiment shown in FIG. 9B, the first connection member 520includes drilling guide members 900 a-900 c, the third connection membercan include guide members 900 d-900 g, and fourth connection member 590includes drilling guide members 900 h-900 j. The quantity of drillingguide members 900, as well as the location and angular orientation ofthe drilling guide members 900 on the resection guide body 580 can varydepending on the patient anatomy, such as configuration of the desiredgraft 408, graft source 403, and type and/or size of the intended bonefixation plate.

Referring to FIGS. 9B-9D, the drilling guide member 900 protrudes fromthe upper surface 581 of the resection guide body 580 along a transversedirection 519. The resection guide body 580 defines a drilling guidebody 902 that extends or protrudes from the upper surface 581 of theresection guide body 580 to a drilling guide tip 903. The drilling guidebody 902 defines an outer surface 906 and an inner surface 908 spacedfrom the outer surface 906. The inner surface 908 defines a throughbore907 that extends through the body 902 between the lower surface 577 ofthe resection body 580 and the tip 903 of the drilling guide body 902.The guide member 900 defines guide member axis 901 extending through andalong the throughbore 907.

The drilling guide member 900 also supports or carries a sleeve 904. Thesleeve 904 can define a sleeve body 905 extending between a distal end904 e and proximal end 904 p spaced from the distal end 904 e along theguide member axis 901. When the sleeve 904 is disposed in the guide body902, the sleeve distal end 904 e is positioned proximate or aligned withthe resection guide lower surface 577 and the proximal end 904 p isproximate to or aligned with the guide member tip 903. The sleeve body905 further defines a throughbore 914 extending through the sleeve body905 between the distal end 904 e and the proximal end 904 p. The sleevebody 905 has an outer surface 910 and inner surface 912 spaced from theouter surface 910. The sleeve 904 is positioned at least partially inthe throughbore 907 of guide body 902 such that the sleeve outer surface910 is adjacent to the guide body inner surface 908. The sleeve bodyinner surface 912 defines a throughbore 914. The throughbore 914 issized to receive a tool therethrough, such as a portion of the drillbit. The guide member body 902 and the sleeve 904 can be formed of thesame or dissimilar materials. The sleeve 904 can be formed of materialssimilar to the resection guide members 60 and 80 discussed above. Whenthe sleeve 904 is formed of a cut-resistant material, for instance ametallic material, drilling accuracy is improved, and tissuecontamination during resection/reconstruction procedure from debris canbe minimized.

Referring to FIGS. 10A-11B, the drilling guide members 900 can beconfigured, for instance oriented, on the resection guide 110 dependingon the patient anatomy contemplated bone fixation plates that will usedto couple the graft 408 to the tissue body 400. For instance, thedrilling guide member 902 can oriented and/or positioned on theresection guide 110 such that the drill bit can form a graft bore 420that is the appropriate size, shape and orientation of the graft source408 so as to receive the bone anchors therein as discussed above. Eachgraft bore 420 can define a graft bore axis 419 that extends along thelength of the bore 420. Referring to FIG. 10A-10C, the drilling guidemember 900 can be configured so that the drilling guide axis 901 definesan angle α with respect to the lateral axis 510. The angle α can beabout 90 degrees as shown in FIG. 10A or oblique. For instance angle αcan be acute as shown in FIGS. 10B and 10C or obtuse (not shown).

As shown in FIG. 10A, the drill guide member 900 is configured such thatthe drilling guide axis 901 intersects and is perpendicular to thelateral axis 510 and the central axis at a point 907, and is parallel oraligned with transverse axis 511. The drilling guide member 900 shown inFIG. 10A can be used to form a graft bore 420 a in the graft source 403that is oriented with drilling guide axis 901 as illustrated, forinstance parallel or aligned with transverse axis 511 of the resectionguide body 580. The dimensions of the graft bore, such as the width anddepth can be control with the drill bit. In the embodiment shown in FIG.10C, the drilling guide axis 901 intersects the lateral axis 510, thetransverse axis 511, and the central axis at a point 907, similar to theembodiment shown in FIG. 10A. The drilling guide member 900 shown inFIG. 10A can be used to form a graft bore 420 c in the graft source 403that is oriented with drilling guide axis 901 as illustrated. Forinstance, the bore 420 c is oriented such that the bore axis 419 isacute with respect to graft source transverse axis 461.

The drilling guide member 900 can be positioned at any location alongthe upper surface 581 of the resection guide body 580 such that theguide member body 905 is perpendicular to the upper surface 581.Referring to FIG. 10B, the drilling guide member 900 is oriented suchthe that guide member body 905 is inclined with respect to the uppersurface 581 such that the drilling guide axis 901 is acute with therespect the lateral axis 510, and intersects the lateral axis 510 at apoint 909 that is offset from the central axis 509 and the transverseaxis 511. In FIG. 10B, drilling guide member 900 is configured such thatthe drilling guide axis 901 is acute relative to the lateral axis 510and intersects the lateral axis 510 at a point 909 that is offset fromthe central axis 509 and lateral axis 511. The drilling guide member 900shown in FIG. 10B can be used to form a graft bore 420 b in the graftsource 403 that is oriented with drilling guide axis 901. For instancethe graft bore 420 b is oriented such that bore axis 419 is at an acuteangle with respect to the graft source lateral axis 461, and is alignedwith the surface of the graft source 403.

Turning to FIGS. 11A and 11B, the drilling guide member 900 can beoriented toward either opposing end 522 or 525 of the resection guidebody 580 such that the drilling guide body 905 defines an angle θ2 withrespect to the upper surface 581. Angle θ2 can be equal to 90 degrees asshown in FIG. 11A or oblique, for instance angle θ2 can be obtuse asshown in FIG. 11B, or acute (not shown). The drilling guide axis 901 candefine an angle β with respect to the central axis 509. Angle β can beequal to about 90 degrees as shown in FIG. 11A, acute as shown in FIG.11B, or obtuse (not shown). The drilling guide members 900 e and 900 fshown in FIG. 11A guides a tool into a graft source 403 to form graftbores 420 e and 420 f that are aligned with the lateral axis 511 of theresection guide body 580, and thus the graft source lateral axis 461.The drilling guide member 900 shown in FIG. 11B guides a tool into agraft source 403 to form graft bores 422 that are oriented toward eitheropposing end 522 or 525 of the resection guide body. Such aconfiguration forms a graft bore 422 that is oriented such that boreaxis 419 is at an acute angle with respect to the central axis of thegraft source 403.

It should be appreciated that the drilling guide member 900 can beoriented in any direction relative to the resection guide body 580 byvarying one or more of the angle α, angle β, angle θ1, and angle θ2angles. For instance, the drilling guide member 900 can disposed on theresection guide body 580 such that at least one of the of angle α andangle β is acute, a right angle, or obtuse. For instance, angle α andangle β can both be acute, right angles, or obtuse angles.Alternatively, angle α can be acute and angle β can be a right angle orobtuse. The drilling guide member 900 can disposed on the resectionguide body 580 such that one or both angle θ1 and angle θ2 is acute, aright angle, or obtuse. The drilling guide members 900 can configuredduring the design and development of the resection guide 110 using thescanning and three-dimensional modeling technologies discussed above.

Referring to FIGS. 12A and 12B, in accordance with an alternativeembodiment of resection guide 1100 configured to resect tissue from thetissue body 400, the resection guide 1100 can be configured to becoupled to the tissue body 400 at the desired resection site. Forexample, the resection guide 1100 can be configured to be coupled to thetissue body 400 so as to define a resection axis 102 a. The resectionguide 1110 The resection guide 110 can be a patient specific resectionguide, designed and manufactured as described above in other embodimentsof the present disclosure, for example similar to the resection guide200 described above. In accordance with the alternative embodiment, theresection guide 1100 can include one or more resection guide members,and one or more drilling guide members 1900 that are configured, or canbe configured, similar to the drilling guide members 900 shown in FIGS.9A-11B. The drilling guide members 1900 guide a tool toward the tissuebody 400 such the tool, such as drill bit can form tissue body bores 430in the tissue body 400 at specific locations that can align the holes ina bone fixation plate used to couple the graft 408 to the tissue body400.

The resection guide 1100 can define a resection guide body 1106extending between a first end 1102 and a second end 1104 spaced from thefirst end along a longitudinal direction 501. The resection guide 1100defines a longitudinal central axis 1101 that is aligned with andextends along the longitudinal direction 501, a lateral axis 1114 thatis perpendicular to the central axis 1101, and a transverse axis 1116that is perpendicular to the lateral axis 1114 and the central axis1101. The lateral and transverse axes 1114 and 1116 may considered firstand second radial axes 1114 and 1116, for instance, when the resectionguide body 1106 has a curved profile.

The resection guide body 1106 defines a flange 1108 disposed at thesecond end 1104 of the resection guide body 1106. The flange 1108 isconfigured to guide a cutting tool toward the tissue body 400. Theflange 1108 protrudes from the resection guide body 1106 along thetransverse direction 519 and the lateral direction 517. The flange 1108includes a first surface 1110 and a second or guide surface 1112 spacedfrom the first surface 1110 along the longitudinal direction 501. Theguide surface 112 is configured to guide a cutting tool toward the grafttissue body 400. It should be appreciated that the flange 1108 can beoriented relative resection guide body 1106 such that guide surface 1112can guide a resection tool 300 along a desired resection axis, such asfirst resection 102 a. The flange 1108 can include coating and/or aplate positioned adjacent the guide surface 1112. The plate (not shown)can size an dimensioned to conform to the surface area of the guidesurface 1112. The plate can be formed of a hardened polymeric materialas described above, or a metallic material or alloy. The plate isconfigured to guide the resection tool, improve cutting accuracy, andminimize debris from being removed from the resection guide body 1106.The coating can be any material, such as a composition, polymer orpolymeric blend applied to the guide surface 1112 so as to create acut-resistant surface. The resection guide 1100 can be formed with anyof the materials and processes described above.

It should be noted that the illustrations and discussions of theembodiments shown in the figures are for exemplary purposes only, andshould not be construed limiting the disclosure. One skilled in the artwill appreciate that the present disclosure contemplates variousembodiments. It should be further appreciated that the features andstructures described and illustrated in accordance one embodiment canapply to all embodiments as described herein, unless otherwiseindicated. Additionally, it should be understood that the conceptsdescribed above with the above-described embodiments may be employedalone or in combination with any of the other embodiments describedabove.

What is claimed:
 1. A resection guide configured to guide a resectiontool toward a skull, the resection guide comprising: a connection bodyconfigured to receive a portion of the skull, the connection bodydefining a lower surface shaped and configured to conform to the portionof the skull; a resection guide body coupled to the connection body soas to project from the connection body along a first direction away fromthe skull when the connection body receives the portion of the skull,the resection guide body defining an upper surface spaced from the lowersurface of the connection body along the first direction, and a pair ofopposed walls, the pair of opposed walls defining respective innersurfaces that at least partially define at least one resection guideopening that extends from the upper surface to the lower surface alongthe first direction, the at least one resection guide opening having alength that extends along a second direction that is perpendicular tothe first direction, wherein the length of the opening is greater than across-sectional dimension of the connection body, the cross-sectionaldimension being parallel to the second direction, wherein the resectionguide body is at least partially made from a first material; and a guidemember including a guide member body and a tab that extends out withrespect to the guide member body, the guide member configured to be atleast partially inserted in the at least one resection guide openingsuch that at least a portion of the guide member body is aligned witheach of the opposed inner surfaces along a third direction that isperpendicular to the first direction and the second direction, and thetab is aligned with the walls along the first direction, the guidemember having a guide member opening that extends through the guidemember body, the guide member opening elongate along a resection axis,the guide member opening configured to receive at least a portion of theresection tool and guide the resection tool along the resection axis,wherein the guide member is at least partially made of a second materialthat is harder than the first material.
 2. The resection guide accordingto claim 1, wherein the second material is a metallic material.
 3. Theresection guide according to claim 1, wherein the first material is apolymeric material.
 4. The resection guide according to claim 1, whereinthe second material has a Brinell hardness ranging between about 10 HBand about 200 HB.
 5. The resection guide according to claim 4, whereinthe second material has a Brinell hardness of about 120 HB.
 6. Theresection guide of claim 1, the guide member defines a guide memberinner surface that at least partially defines the guide member opening,wherein the guide member inner surface is configured to contact theresection tool as the resection tool is guided along the resection axis.7. The resection guide of claim 1, wherein the at least one resectionguide opening is elongate along a first axis that is aligned with theresection axis.
 8. The resection guide of claim 1, wherein the resectionguide defines at least one drill guide opening spaced from the at leastone resection guide opening, wherein the at least one drill guideopening extends through the resection guide.
 9. The resection guideaccording to claim 6, wherein the guide member body includes a guidingfront wall, a guiding rear wall opposite to the guiding front wall, anda pair of guiding side walls that extend from the guiding front wall tothe guiding rear wall, wherein the guiding front wall, the guiding rearwall and the pair of guiding side walls A) at least partially define theguide member inner surface, and B) extend along the inner surface of therespective at least one guide opening when the at least one guide memberis inserted into the respective at least one guide opening.
 10. Theresection guide according to claim 1, wherein the opposed inner surfacesextend from the upper body surface toward the lower body surface in thefirst direction.